ABSTRACT
Background: The COVID-19 pandemic has brought significant changes to the delivery of healthcare while increasing care needs in certain areas. To decrease the risk of transmitting the novel coronavirus to patients and healthcare workers, care providers have had to make major changes in their practice, such as increased use of telemedicine services. Many cancer centers also had to modify their cancer care while adopting telemedicine in a very short time. Objectives: To present the 4-week journey that our comprehensive cancer center underwent to implement telemedicine service during the pandemic, lessons learned from the process, and future directions for telemedicine use in cancer care. Methods: The telemedicine implementation process used in our cancer center was consistent with the steps suggested by the American Medical Association. The main steps included a needs assessment, identification and purchase of software and hardware, development of workflow and documentation mechanisms, preparation of clinicians and other team members, and patient education, as well as follow-up of implementation services, such as volume statistics, patient satisfaction surveys, and opportunities for improvement. Results: During the first 6 months of telemedicine service, the number of outpatient visits via televisit increased significantly, from 0 to 2156 visits by the end of September 2020. Feedback from patient satisfaction surveys was positive. The most appreciated aspect of telemedicine visits for patients was the ability to connect with their providers from home. No major complaints from patients or resistance from providers and staff were reported. Telemedicine service in our center has been undergoing continuous enhancements, and the service coverage has been increasing, including survivorship care appointments, social work interventions, caregiver support, and advance care planning. Conclusion: Telemedicine is likely here to stay, with increasing capacity in the current eHealth ecosystem. Further efforts must be made to generate evidence for its effectiveness in improving patient outcomes and experiences while establishing best practice approaches.
ABSTRACT
OBJECTIVE: The aim of this paper is to describe evolution, epidemiology and clinical outcomes of COVID-19 in subjects tested at or admitted to hospitals in North West London. DESIGN: Observational cohort study. SETTING: London North West Healthcare NHS Trust (LNWH). PARTICIPANTS: Patients tested and/or admitted for COVID-19 at LNWH during March and April 2020 MAIN OUTCOME MEASURES: Descriptive and analytical epidemiology of demographic and clinical outcomes (intensive care unit (ICU) admission, mechanical ventilation and mortality) of those who tested positive for COVID-19. RESULTS: The outbreak began in the first week of March 2020 and reached a peak by the end of March and first week of April. In the study period, 6183 tests were performed in on 4981 people. Of the 2086 laboratory confirmed COVID-19 cases, 1901 were admitted to hospital. Older age group, men and those of black or Asian minority ethnic (BAME) group were predominantly affected (p<0.05). These groups also had more severe infection resulting in ICU admission and need for mechanical ventilation (p<0.05). However, in a multivariate analysis, only increasing age was independently associated with increased risk of death (p<0.05). Mortality rate was 26.9% in hospitalised patients. CONCLUSION: The findings confirm that men, BAME and older population were most commonly and severely affected groups. Only older age was independently associated with mortality.